#perthan
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The ships in the polls are the twelve (12) most popular romantic ships for each character based on the number of fics on AO3. These are not platonic ships. Any ship hate at all will result in haters being blocked.
#ethan nakamura#pjo hoo toa#polls#percy jackson#luke castellan#leo valdez#rachel elizabeth dare#pjo pollux#chris rodriguez#jason grace#bianca di angelo#nico di angelo#pjo octavian#drew tanaka#travis stoll#lukethan#perthan#ethanico#ethanca#ethason#drethan#ethavian#trathan#chrethan#leothan#ethollux#rachethan
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I did the Top 100 PJO Ships (according to AO3) and these ships were at the bottom of the list. I want to see the numbers. Don't forget that there are the Bottom 10 F/M and F/F polls to vote in too (they'll be linked in the reblog).
Fav of the top 10 f/f ships (poll closed)
Fav of the top 10 f/m ships (poll closed)
Fav of the top 10 m/m ships (poll closed)
#pjo#stollercy#nicotavian#litpollo#hephercy#jasotavian#willeo#soldez#lukico#stollcest#grovercy#perthan#riordanverse#percy jackson series#polls#anyone who clowns on this poll will get blocked
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hey i've become weirdly attached to ithan and perry so... what's their ship name? perthan? or maybe do a last name one like quinlar... ravenstrom??
#help a girl out#hofas spoilers#cc3 spoilers#house of flame and shadow spoilers#crescent city#ithan holstrom#perry ravenscroft#ithan x perry#tp
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This was a fun one! I was asked by some folks at Tamriel Rebuilt to take the design of the Spider Daedra (or Perthan) from An Elder Scrolls Legend: Battlespire (pictured here!) and update it as if it were made for the world of The Elder Scrolls III: Morrowind. See, it's a totally different style...! Morrowind's look is a bit more grounded, I think. I am quite fond of the original design, though, it's really got that cheesy-but-cool 90s adventure game look, haha.
I do wonder if Tamriel Rebuilt ever made anything from my design?
#morrowind#elder scrolls#battlespire#adventure#fantasy#scifi art#fantasy art#scifi#character design#creature design#monster design#monster art#spider#90s aesthetic#pc games
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"Why should we fight? Perhaps there is something you want… something I'd be happy to give you…"
"I enjoy a challenge, and a good workout… but more stimulating exertions might satisfy us both."
"Your form is pleasing, mortal. To mar such grace with weapons is a pity… I'd far prefer to wrestle."
--Perthan Vorn, Spider Daedra, attempting to seduce you so you lower your guard.
#UESP#The Elder Scrolls#Battlespire#Spider Daedra#Lore#The Exact Opposite of Bards Attempting to Seduce the Monster
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Hey everyone! My name is Jade, and my muse is Avani. Her basic information is below, and her biography, if you’re interested in learning more about her. I’m so excited to join you guys!
Name: Avani Carrington
Age: 19
Pronouns: She/Her
Hometown: New York City/Cottonwood Falls, Kansas
Time lived in Atlanta: Three weeks
Occupation: Bartender
Character quote: “Normality is a paved road: it is comfortable to walk, but no flowers grow,” - Vincent van Gogh
Biography - Tw: mental illness
Avani was born to parents Royce Bush and Nina Carrington. Royce was a wealthy forty year old man when Avani was born, while Nina was only twenty, and was manipulated into being in a relationship with Royce. Avani’s father left shortly after she was born, so she was raised by her mother, a sweet and hardworking woman, though raising Avani by herself took a toll on her mental health.
When Avani was six, they moved from New York City to Cottonwood Falls, Kansas, so Nina and Avani could be supported by Avani’s grandparents. As time went on, Avani’s mother began acting weirdly, her behavior becoming more and strange with each passing month. After a doctor’s appointment that was forced upon Nina by her parents, Avani’s mother was diagnosed with severe schizophrenia. She was admitted to a mental hospital in Wichita, Kansas, an hour and a half away from where they lived.
Avani went to live with her grandparents, Susan and Jude, who were very traditional people and refused to accept Avani’s love of photography and journalism. They insisted she pursue a more traditional career in law or science. As Avani’s creative occupational ambitions grew, so did the rift between Avani and her grandparents. Susan and Jude were also unforgiving of Avani’s sense of style and classmates. Because of the hour and a half distance between Cottonwood Falls and Wichita, Avani was rarely able to visit her mother, who was making little to no improvement. And, because of how small their town was, Avani had to deal with the constant whispers about her “crazy mother,” and the expectation that she would turn out just as broken and psychotic as her mom.
Avani attempted to go to college in Cottonwood Falls under the watchful eyes of her grandparents and the entire town, but she got tired of the pressure and expectations. Around this time, her grandparents told her that her father, Royce Bush, was discovered dead in his home. He overdosed on an unknown but very hard drug. Shortly after she turned 19, she took all of her belongings and fled to Atlanta, Georgia, not knowing how to deal with her indirect pain and emotional turmoil. She started bartending at Perthan, a popular nightclub in Atlanta, to be able to pay the bills and support her continuing love of journalist and photography, and now lives in an apartment in Downtown Atlanta.
She is creating her entire life here in Atlanta, including her friends, career, and love life. She loves and craves constant change and loves meeting new people. She is unintentionally very charming, and hopes to have an impact on the people of Atlanta.
Personality -
+ Hardworking
+ Ambitious
+ Dependable
+ Fun
+ Loyal
- Disorganized
- Impulsive
- Sarcastic
- Unpredictable
- Argumentative
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How Much Does an Air Conditioner Installation Cost in Perth for Residential and Commercial?
When you plan to buy air conditioner for your Perth home, one of the first thing you need to decide upon is your budget. It’s not just the cost of the split or ducted air conditioning unit but also installation.
Langler Air prides itself in being the best air conditioner installer in Perth. Our dedicated team has accomplished over 10,000 installations since 1995. If you are looking for the best brands of air conditioners with equally high customer service and installation, reach out to us here or call us at (08) 9228 3555.
Reverse Cycle Air Conditioners
The Reverse cycle air conditioning systems can come in a split AC design or ducted system. Reverse cycle air conditioners perform both heating and cooling functions.
At Langler Air, we offer both split and ducted reverse cycle air conditioning systems from reputed brands all across Australia with expert reverse cycle AC installation.
The installation charges of an air conditioner depend on the model you choose. Here are the two common types of air conditioners available in Western Australia.
1. Split System Air Conditioner
One of the most common air conditioning systems are split system air conditioners. These typically are divided into two units. The outdoor unit consists of the condenser and compressor, and the indoor unit consists of the distribution channel where the cool (or hot) air flows out of.
Langler Air has an extensive range of split air conditioners for the best compact designs. Our advanced ACs can also be controlled through your smart phones and offer additional benefits, including air purification and de humidification.
2. Ducted Air Conditioner
Unlike split system air conditioners, ducted air conditioners distribute the cool air from a central cooling system across your house through ducts installed within the ceilings.
Ducted AC Installation requires high professional expertise. Our trained technicians are proficient in every type of ducted AC installation, regardless of the interior construction of your Perth home. With our ducted air conditioning systems and installation team, ducted AC installation is worry free for our home owners.
Our aircons are also compatible with Advantage Air, a user-friendly interface that enables remote temperature control for the entire house from one interface.
Installation Cost: Air Conditioner Pricing Perth
An air conditioner installation cost in Australia will depend on the model you choose and the service provider. Here is a cost guide on air conditioner installation costs to help you get an idea.
Based on Model
1. Split System AC Installation
The cost for installing a split AC reverse cycle system in Australia is approximately the same and can range from anywhere between $600 – $750 per unit. These air conditioners should be installed by a licensed technician only.
The hourly cost of the installer is approximately $60–$110 per hour, along with GST charges.
Our aircons are long-lasting, cost-effective and deliver outstanding performance consistently. If you are looking for efficient yet affordable air-cons, contact us for a free quote.
2. Ducted Reverse Cycle AC Installation
Since ducted AC installation requires setting up multiple vents and ducts throughout your house, the charges are comparatively higher. Along with the unit, it can cost anywhere between $6000 to $12,000 to get a ducted AC system installed.
At Langler Air, we offer premier conditioning service at an affordable price. You can visit our website to get a free quote on your ducted AC installation.
Based on Property Size – Ducted
1. Small Homes
If you are looking for an air conditioner for a small starter home, a 7kW or 10kW model will be enough. The cost will vary from $7,500 – $9,500, depending on the brand and outlets.
2. Mid Size Homes
Mid-size homes in Perth. Depending on the property area, you will probably need a 10kW or 12.5kW model ranging from $8,500 – $10,500.
3. Larger Family Homes
If you have a big family and a huge house, naturally, you will need a higher capacity aircon which can range from a 12.5kW – 14.0kW model to a 14.0kW – 17.0kW model. We suggest for this range; you keep a budget of $9500 to $14,000.
Options at Langler Air are never limited. Want a bigger air conditioner? Check our range of brands on our website.
For further information or any questions you may have, send us a messageor call us at (08) 9228 3555 to discuss your requirements better.
Based on Property Size – Split Systems
Commercial v/s Residential AC Installation
Air conditioning pricing Perth depends greatly on the purpose of use. If you are using the air conditioner for commercial purposes, we need to factor in a lot more.
Although the exact cost of installing commercial air conditioners will depend on the unit, the hourly cost can range from $80–$140 per hour, along with GST charges.
Since commercial units are designed to cool larger space, they are usually of higher capacity, making the unit costlier than residential ACs.
Final Thoughts
The installation of the air conditioning unit plays a major role in determining how well the unit will run. At Langler Air, we have been installing aircon of every type since 1995. Our knowledge, expertise and techniques ensure that you only get the best air conditioner installation in Perth.
Send us a message here, or shoot an email to [email protected] to book your brand new aircon today!
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Indian Traditional Clothing for Women
India's customary garments styles are famous the world over for their excellence, appeal and tastefulness. Ladies of any age have consistently wanted to wear conventional Indian attire. Indeed, they have never lost their charm even notwithstanding hardened rivalry from Western dresses.
Customary dresses reflect the extraordinary social legacy of the country. Today, Indian outfits are respected the most marvelous and extraordinary ones on the planet. Here are three most well known sorts of Indian dress for ladies.
Sarees - Saree has for quite some time been known to be perhaps the most lovely dresses on the planet. It is likewise the most generally utilized clothing by Indian ladies. There is an astounding assortment of sarees accessible in various pieces of the country. A portion of the famous kinds of sarees are creator cotton sarees, silk sarees, perthane, bandana, silk, handloom sarees, and so forth There are heap methods of hanging the saree also, every one of them remarkable and lovely in its own particular manner. Sarees complement the gentility of a lady. Sarees highlighting sensitive string work, lavish examples and weaving, and themes are incredible masterpieces. Wedding sarees are made of heavier textures and contain more craftsmanship.
Salwar Kameez - Salwar Kameezes are the smartest choice for the metropolitan ladies. It is quite possibly the most agreeable dresses. Involving a long tunic and free night robe, they are worn by ladies of all age gatherings. The tunic can either be till the knee or even reach out till the lower leg. There are various styles of the Salwar Kameez, like the Afghani style, kurtis, Patiala style, sharara, etc. Today you can discover a variety of salwar kameezes in various plans and examples. Accessible in various textures, they can be worn across all seasons.
Lehenga - This is one of the most loved wedding outfits worn by the Indian women. Lehengas are fine works of creation including broad weaving work that gives a lofty look.
The many-sided plans and imperial loftiness of the Indian clothing types have placed India in the worldwide design scene. Today, there is a wide scope of garments choices accessible for Indian ladies. Directly from in vogue western outfits to ethnic conventional wear, there are a lot of alternatives. With such innumerable alternatives accessible, the purchaser is spoilt for decision. There is an accessible thing for each size, shape and age bunch. You can peruse the broad assortment of garments at various stores and pick the one that suits you best.
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Serumi antiakne dhe imperfeksioneve te lekures: •Perthan aknet •Pastron poret •Balancon yndyren •Ndihmon ne zbehjen e shenjave te akneve dhe njollave te lekures •Ka efekt lifting Serumi permban propolis blete,mjalte,qumesht blete,aloe vera,tea tree oil dhe vaj temjani. Perdoret cdo mengjes dhe mbremje ne fytyre te paster para perdorimit te kremit hidratues. Sasia:20 ml Cmimi:1500 lek Skadenca:3 muaj. Pergatitet i fresket ne momentin qe beni porosine tuaj. l🔰🔰🔰🔰🔰🔰🔰🔰🔰🔰l #K_O_N_T_A_K_T_O_N_I Porositni online instadirect ose ne #Tel : 0693664000. ➡️Gjithcka 100% natyrale nga prodhimet e bleteve tona.🐝🐝🐝 #instagram @mjalte_qumesht_blete @mjalte_qumesht_blete l🔰🔰🔰🔰🔰🔰🔰🔰🔰🔰l (at Durres, Albania) https://www.instagram.com/p/B7tKsRtAUN3/?igshid=1svstsqt7liw0
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Se encuentra desapareciodo el joven Jose Cruz en Perthan Amboy NJ.
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Top 100 PJO ships (according to AO3)
#pjo#perodite#perthan#octachel#grovercy#ugliason#thalico#nicobeth#calyper#peranca#perstia#percy jackson series#riordanverse#polls#anyone clowning on this post gets blocked
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World-building: The Caledonii 92nd Reconnaissance Battalion, 'Argyll & Sutherland Highlanders’
The planet of Caledonii had been, so far in the war, one of the few planets that didn't have a regiment or division to call its own. This was rectified when the 92nd Reconnaissance Regiment was activated on 18 September, 2539. The regiment quickly picked up the nickname 'Argyll & Sutherland Highlanders', and as such will henceforth be referred to as the Highlanders. The regiment was usually attached to other divisions, serving as their reconnaissance. The troops were not supposed to 'hold the line', instead trained for infiltration and stealth. They shunned helmets, preferring boonies or berets to signify their semi-elite status. Unfortunately, they didn't usually see their original purpose.
The Highlanders only existed for three years. The rest of the first year was largely spent training for the various climates they would be fighting in. Jungle training, SERE, arctic, desert -- you name a climate and a scenario, and they tried to train for it.
The battalions split off one at a time. The First Battalion went to the planet Abyssinia in 2540. They fought a long and protracted campaign while attached to the 16th Abyssinian Division, mostly fought over various islands Trapped around a single spaceport in the city Heraklion, the first battalion escaped by the skin of their teeth. They lost many a man both on the ground and in the freighters trying to escape. Regrouping with the Second Battalion back on Caledonii, they were given two weeks' rest and then sent to the planet of Alamein in 2541.
The fight for Alamein was the only victory they ever saw. Attached to the 161st Division, they fought across the vast deserts of the planet; meeting and defeating the Covenant at every corner. The campaign still took its toll. By the end of it, only three dozen men from both battalions could say they were unscathed. The Third Battalion was shipped in at the end of the campaign, and the reformed regiment was deployed to the planet of Atlas IV on November 7, 2541. Though attached to the 45th Division, they were mostly given R&R and time to train the new replacements. Or so it was hoped. Instead, not even a week later, the Covenant found the planet. They didn't bother to land, only glassing it.
The UNSC Navy fought a three week long battle over the planet, allowing civilians and military personnel alike to escape; at the cost of three dozen vessels who held the line. The last of the Highlanders and the 45th were evacuated aboard UNSC Trench Café (FFG-219) on December 7, just as the planet began to be glassed. Only a tiny fraction of the planet's two billion population had escaped.
Café and the other vessels landed their military charges on the planet of New Malaya. Unbeknownst to them, the Covenant were following, but they had a month's time. Colonel Ian Stewart led the regiment into the jungle to give the harshest training he could think of, and as a result, the Highlanders were one of the most effective units in the coming campaign.
The Covenant made landfall on January 17, 2542. The Highlanders were nicknamed the 'Jungle Beasts' by the 45th division, but the Highlanders were used mostly in 'hold the line' missions.
The battle for New Malaya was a disaster for the UNSC, being a near-constant rout, but the Highlanders inflicted frightening casualties on the Covenant. Every time the UNSC would withdraw, the Highlanders set up ambush positions in the jungle and held back the Covenant.
Eventually, they were so depleted they were ordered over the causeway to New Singapore, in order to be evacuated from the planet. Two days later, an Australian officer of the 22nd Perthan Brigade - the absolute rear guard of the UNSC army - and the 2200 men remaining of his force arrived at the causeway. He was amazed to find all 250 remaining Argylls camped on the wrong side of the causeway. They were all that remained of the entire regiment, who'd fought delaying actions for the past six weeks. When asked why they weren't in the relative comfort of New Singapore, the response from Col. Stewart was "You know the trouble with you Australians is that you have no sense of history. When the story of this campaign is written you will find that the Highlanders goes down as the last unit to cross this causeway what's more – piped across by their pipers."
Having lost 1750 men, they had taken near 90% casualties. When the Marathon-class cruiser UNSC Plymouth (C-87) went down, the surviving marines were attached to the Highlanders as some semblance of reinforcements. They changed their name to the 'Plymouth Argylls' to acknowledge this fact.
Once in Singapore, the Plymouth Argylls fought a dozen last actions. Still being deployed as the rearguard, they did everything they could to keep the Covenant back. The delaying tactics of the Argylls and their sheer bravery gave many the chance to escape from New Singapore -- including what remained of the division they were attached to. One Corporal Barclay was among these lucky few.
They forced the Covenant to fight for every inch of New Singapore. Eventually, they dug in along the Bukit Timah road; and there they stayed. Cut off, surrounded, nearly out of ammunition, with no medical supplies or foodstuffs remaining.
Their last stand took three days, ending 15 February, drawing seven of the eight Covenant divisions attacking New Singapore to themselves. Their sacrifice allowed the 45th Division and other units to escape aboard the scant few remaining UNSC vessels.
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Ca t bej qe t pastroj ftyren?help me please
Une kam bere analiza dhe doli qe ajo cfare me shkaktonte pucrrat ishte sheqeri, keshtu qe eleminova embelsirat, keshtu jane dhe shumica e njerzve te tjere sepse sheqeri eshte shume i prirur per te krijuar mbetje dhe keshtu dalin pucrra, ama njoh dhe disa veta qe kte ja shkakton bulmeti, pra thelbi eshte te hash sa me shendetshem. E dyta eshte qe te shkosh te vizitohesh ke ndonje dermatolog, te sugjeroj farmaci dajen, mbasdite eshte daja aty, nuk te jep as kokrra asigje sepse une ato kisha problem se me jepnin shume efekte anesore, thjesht mund te te japi ndonje lende qe ti perthan pjeset e infektuara dhe pune 2 javesh ke per te pasur nje permirsim rrenjesor. Po dhe nese nuk shkon tek daja, ndonje lloj kremi ose alkooli keshillohet patjeter, po varet nga tipi i pucrrave qe ke
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NGỘ ĐỘC THUỐC TRỪ SÂU PHOSPHO HỮU CƠ Ở TRẺ EM
PHÁC ĐỒ ĐIỀU TRỊ NGỘ ĐỘC THUỐC TRỪ SÂU PHOSPHO HỮU CƠ Ở TRẺ EM
I. ĐẠI CƯƠNG
Các thuốc trừ sâu chứa phospho hữu cơ hoặc Carbamate như Monitor, Basudin, Wolfatox... gây ức chế men Acetylcholine esterase làm ứ đọng acetylcholine tại synapse thần kinh, biểu hiện lâm sàng bằng ba hội chứng: muscarinic, nicotinic và thần kinh trung ương. Trong đó Carbamate sự ức chế men thường tự giới hạn, hồi phục trong vòng 24 giờ nhẹ hơn và ngắn hơn so với Phospho hữu cơ.
Ngộ độc có thể qua đường uống, hít hay qua da, tử vong chủ yếu do suy hô hấp thường xảy ra trong 2 - 5 ngày đầu.
Thuốc trừ sâu chứa phospho hữu cơ: Thiophốt (Parathion) - Vôfatốc (methyl parathion) - Dipterec - DDVP (dichloro diphenyl vinyl phosphat), Clorpyriphos.
Thuốc trừ sâu chứa Carbamate: Bendiocarb (Coarvox, Seedox); Butocarboxim; Carbaryl (Sevin); Carbofuran (Furadan, Curaterr); Cartap; Fenobucarb (Bassa, BPMC, Baycarb,...); Isoprocarb (Mipcin, MIPC), Methiocarb (Mesurol); Propoxur.
II. CHẨN ĐOÁN
1. Chẩn đoán
• Bệnh sử: tiếp xúc với thuốc bảo vệ thực vật.
• Lâm sàng:
- Dấu hiệu Muscarinic: co đồng tử, tăng tiết đờm nhớt, đau bụng, tiêu chảy chậm nhịp tim, hạ huyết áp.
- Dấu hiệu Nicotinic: rung thớ cơ, yếu liệt cơ, tim nhanh, cao huyết áp.
- Dấu hiệu thần kinh trung ương: nhức đầu, hôn mê, co giật.
• Cận lâm sàng:
- Tìm Phospho hữu cơ trong dịch dạ dày.
- Định lượng men Acetylcholinesterase trong hồng cầu và huyết tương: giảm trên 50% bình thường.
- Trong trường hợp nặng: lon đồ, đường huyết, chức năng gan thận, X-quang phổi.
2. Phân độ nặng
• Nhẹ: chỉ có hội chứng Muscarinic đơn thuần. Men Acetylcholin esterase còn 20 - 50% bình thường.
• Trung bình: hội chứng Muscarinic kèm hội chứng Nicotinic, thần kinh trung ương nhưng chưa suy hô hấp, tuần hoàn. Men Acetylcholinesterase còn 10
- 20% bình thường.
• Nặng: suy hô hấp, sốc, hôn mê. Men Acetylcholinesterase còn < 10% bình thường.
3. Chẩn đoán xác định
• Bệnh sử tiếp xúc với thuốc bảo vệ thực vật.
• Lâm sàng có hội chứng Muscarinic, Nicotinic, thần kinh trung ương.
• Rửa dạ dày có mùi thuốc trừ sâu.
• Xét nghiệm: men Acetylcholinesterase giảm. Có Phospho hữu cơ trong dịch dạ dày.
• Trong trường hợp nghi ngờ có thể dùng Test Atropin để xác định: Atropin
0,02 mg/kg (TM) nếu đồng tử không dãn, không đỏ da, mạch không tăng là ngộ độc Phospho hữu cơ hoặc Carbamate.
4. Chẩn đoán phân biệt
Cần chẩn đoán phân biệt với ngộ độc Clor hữu cơ vì Atropin làm nặng hơn tình trạng bệnh nhân. Trong ngộ độc Clor hữu cơ triệu chứng chính là thần kinh, co giật. Xử trí: loại bỏ độc chất, chống co giật. Không có chất đối kháng.
Thuốc bảo vệ thực vật Clor hữu cơ: Lindan, Thiodan, Endosulfan, DDT, Toxaphen, Metox, DMDT, Perthane, Chlordane, Heptachlor, Aldorin, Endrin, Dieldrin...
III. ĐIỀU TRỊ
1. Nguyên tắc điều trị
• Điều trị tình huống cấp cứu.
• Loại bỏ độc chất.
• Chống tác dụng của acetylcholin.
• Bình thường hóa men Acetylcholinesterase.
• Điều trị biến chứng.
2. Điều trị
• Điều trị các tình huống cấp cứu: suy hô hấp, co giật, sốc, hôn mê.
• Lập ngay đường truyền tĩnh mạch: để tiêm Atropin.
• Atropin:
- Atropin có tác dụng đối kháng triệu chứng Muscarinic, là thuốc chủ yếu điều trị ngộ độc Phospho hữu cơ và Carbamate.
- Atropin phải được tiêm trước và trong khi rửa dạ dày.
- Liều Atropin: 0,02 - 0,05 mg/kg (TM) mỗi 15 phút cho đến khi có dấu thấm Atropin.
- Mục tiêu mong muốn là duy trì dấu hiệu thấm Atropin (hết ran phổi, đồng tử hơi dãn 3-4mm) trong 12-24 giờ, tránh đưa đến tình trạng ngộ độc Atropin (sảng, sốt cao >39oC, đỏ da, đồng tử dãn to).
- Sau đó khi có dấu hiệu thấm Atropin:
+ Giảm liều tĩnh mạch đang dùng cho đến 0,02 mg/kg, sau đó sẽ tiêm tĩnh mạch cách quãng xa hơn.
+ Hoặc truyền TM liên tục 0,02 - 0,08 mg/kg/giờ.
- Nếu trong quá trình truyền Atropin trẻ xuất hiện triệu chứng ngộ độc Atropin phải ngừng ngay Atropin, theo dõi sát đến khi hết dấu hiệu ngộ_ độc Atropin sẽ cân nhăc chọn liều Atropin thích hợp thấp hơn liều đang truyền.
- Khi bệnh nhân ổn định với liều truyền tĩnh mạchthấp hơn 0,02 mg/kg/giờ hoặc đang tiêm TM cách khoảng 1 giờ, sẽ chuyển sang TDD mỗi 2-4 giờ. Khi bệnh nhân xuất hiện lại dấu ngộ độc cho biết liều hiện tại là thấp, cần tăng liều Atropin.
- Thơi gian điều trị Atropin tùy mức độ nặng, trung bình thường từ 3-5 ngày.
- Nên chọn loại Atropin đậm đặc 1mg/1ml để tránh ngộ độc nước, hạ natri máu.
• Rửa dạ dày:
- Thực hiện càng sớm càng tốt.
- Rửa dạ dày lại dù tuyến trước đã rửa.
- Rửa dạ dày với dung dịch Natriclorua 0,9%.
- Rửa kỹ đến khi nước trong và không mùi, thường 20-30 lít.
- Nếu sau 3 giờ tình trạng chưa cải thiện có thể rửa dạ dày lại lần 2.
• Than hoạt tính.
• Pralidoxim:
- Pralidoxim (2PAM: 2 Pyridin Aldoxim Methochlorid).
- Tác dụng: hoạt hóa lại men Acetylcholinesterase, cải thiện tốt hội chứng nicotinic đặc biệt là liệt cơ hô hấp.
- Phối hợp sớm với Atropin trong các trường hợp ngộ độc Phospho hữu cơ nặng, cải thiện tử vong.
- Thường không chỉ định trong ngộ độc Carbamate.
- Chỉ định: trong trường hợp ngộ độc Phospho hữu cơ nặng:
+ Ngừng thở, suy hô hấp.
+ Yếu cơ, run thớ cơ.
+ Uống lượng nhiều, hoặc loại thuốc có độc tính cao.
- Nên dùng sớm trong 12-24 giờ đầu.
- Biệt dược: Pampara 500mg, Contrathion 200mg, Protopam 500mg.
- Cách dùng: 20-50 mg/kg/lần (tối đa 1g) pha trong 100 mL Normal saline TTM trong 30 phút-1 giờ, có thể lặp lại sau 1-2 giờ nếu chưa cải thiện tình trạng suy hô hấp. Liều kế tiếp cách mỗi 10-12 giờ, cho đến khi mất các biểu hiện Nicotinic. Trong những ca nặng, sau liều đầu tiên có thể thay liều cách quãng bằng cách TTM liên tục 10-20 mg/kg/giờ.
- Tác dụng phụ: truyền nhanh có thể gây nhức đầu, buồn nôn, tim nhanh, co gồng cơ.
• Điều trị rối loạn điện giải: cần chú ý tình trạng hạ Natri máu do rửa dạ dày, nhất là khi rửa dạ dày với nước thường không dùng dung dịch Natriclorua 0,9%.
• Xem xét thay huyết tương (plasmaphenisis) trong trường hợp ngộ độc nặng đang thở máy kèm thất bại với điều trị Atropin + PAM liều cao.
• Dinh dưỡng: sau giai đoạn cấp cứu truyền Atropin băt đầu cho ăn bột hoặc cháo đường sau đó cháo thịt nạc hạn chế mỡ, lipid, sữa.
IV. THEO DÕI
• Mỗi giờ đến khi ổn định ít nhất là 72 giờ.
• Mạch, nhiệt độ, huyết áp, nhịp thở, tri giác.
• Kích thước đồng tử.
• Ran phổi.
• Đỏ da, cầu bàng quang.
• Sau khi ổn đjnh cần theo dõi tiếp ít nhất là 72 giờ đầu để phát hiện hội chứng trung gian yếu liệt chi, liệt hô hấp.
.Bài viếtNGỘ ĐỘC THUỐC TRỪ SÂU PHOSPHO HỮU CƠ Ở TRẺ EM xuất hiện lần đầu tại website http://khamgiodau.com
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